救援人员创伤后应激障碍早期易感筛查模型的初步建立  

Preliminary establishment of the early susceptibility screening model for post-traumatic stress disorder in rescue workers

作　　者：罗廷刚 孙媛媛[1] 陈巧[1] 陈娟[1] 姜荣环[2] 李世忠 赛晓勇[1] LUO Tinggang;SUN Yuanyuan;CHEN Qiao;CHEN Juan;JIANG Ronghuan;LI Shizhong;SAI Xiaoyong(Institute of Geriatrics,Chinese PLA General Hospital,National Clinical Research Center for Geriatric Diseases,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心老年医学研究所,国家老年疾病临床医学研究中心,北京100853 [2]解放军总医院第一医学中心医学心理科,北京100853 [3]陆军航空兵学院科研学术处,北京101123

出　　处：《中国急救复苏与灾害医学杂志》2020年第6期739-742,745,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市科技计划课题“首都特色”项目(编号:Z181100001718007);国家科技支撑计划课题(编号:2013BA18B01);解放军总医院转化医学项目(编号:2017TM-023);军队医药卫生成果扩试项目(编号:17WKS25)。

摘　　要：目的 明确某部救援人员创伤后应激障碍(Post-Traumatic Stress Disorders,PTSD)的筛查阳性率及相关危险因素,建立早期筛查模型,为早期识别PTSD提供筛查工具.方法 采取整群抽样方式,对某部全体救援人员社会人口学、行为学和心理学相关因素进行横断面调查,运用Logistic回归分析相关因素,构建早期筛查模型并绘制诊断试验ROC曲线,与创伤后应激障碍检查表(PCL-5)及联合诊断模型进行比较.结果 该部救援人员PTSD筛查阳性率为0.66%,心情低落沮丧或绝望(OR:6.565,95%CI:2.505~17.209,P=0.000)、失眠(OR:25.823,95%CI:2.505~17.209,P=0.002)和入伍时间(OR:2.196,95%CI:1.090~4.423,P=0.028)可显著预测PTSD筛查阳性.分别使用PCL-5量表和筛查模型进行检验发现AUC及95%CI分别为0.898(0.878~0.916)和0.968(0.954~0.977),联合诊断AUC及95%CI为0.987(0.979~0.993).结论 该部救援人员筛查PTSD阳性可能与心情低落沮丧或绝望、失眠和入伍时间相关.应围绕睡眠和心理教育进行健康管理.Objective To investigate burden of Disease of FTSD and related risk factors in 1 059 rescue personnel and explore an early screening model.Methods Cluster sampling was adopted to conduct a cross-sectional investigation on the relevant factors of social demography,behavior and psychology of all rescue workers in a certain department.Logis­tic regression analysis was used to analyze the relevant factors,construct the early screening model and draw the ROC curve of diagnostic test,and then compare it with PCL-5 and the joint diagnostic model.Results It was found that the positive rate of structured screening for PTSD among the active service members was 0.66%,and the positive rate of screening for PTSD was significantly predicted by self-reported depression or despair(OR:6.565,95%CI:2.505〜17.209,P=0.000),self-reported insomnia(OR:25.823,95%CI:2.505-17.209,P=0.002)and time of enlistment(OR:2.196,95%CI:1.090~4.423,P=0.028).PCL-5 scale and the screening model were used to test,and found that AUC and 95%CI were 0.898(0.878~0.916)and 0.968 respectively(0.954~0.977),and the combined diagnosis AUC and 95%CI 0.987(0.979-0.993).Conclusion The FTSD screening positive rate was significantly correlated with depression,de­spair,insomnia and enlistment time.Health management should revolve around sleep and psychological education.

关 键 词：创伤后应激障碍 筛查模型 危险因素 救援人员 

分 类 号：R129[医药卫生—环境卫生学]